Provider Demographics
NPI:1164283081
Name:NICHOLS, TAWNYA MAE
Entity Type:Individual
Prefix:
First Name:TAWNYA
Middle Name:MAE
Last Name:NICHOLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18592 EDWARDS RD LOT 215
Mailing Address - Street 2:
Mailing Address - City:DOYLESTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44230-9565
Mailing Address - Country:US
Mailing Address - Phone:330-907-3820
Mailing Address - Fax:
Practice Address - Street 1:16 RHODES AVE APT 23
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1434
Practice Address - Country:US
Practice Address - Phone:330-907-3820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-18
Last Update Date:2024-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health